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ANATOMIC and PATHOLOGIC ASSESSMENT of FELINE LYMPH NODES USING COMPUTED TOMOGRAPHY and ULTRASONOGRAPHY Mauricio Tobón Restrepo

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ANATOMIC and PATHOLOGIC ASSESSMENT of FELINE LYMPH NODES USING COMPUTED TOMOGRAPHY and ULTRASONOGRAPHY Mauricio Tobón Restrepo ADVERTIMENT. Lʼaccés als continguts dʼaquesta tesi queda condicionat a lʼacceptació de les condicions dʼús establertes per la següent llicència Creative Commons: http://cat.creativecommons.org/?page_id=184 ADVERTENCIA. El acceso a los contenidos de esta tesis queda condicionado a la aceptación de las condiciones de uso establecidas por la siguiente licencia Creative Commons: http://es.creativecommons.org/blog/licencias/ WARNING. The access to the contents of this doctoral thesis it is limited to the acceptance of the use conditions set by the following Creative Commons license: https://creativecommons.org/licenses/?lang=en Doctorand: Mauricio Tobón Restrepo Directores: Yvonne Espada Gerlach & Rosa Novellas Torroja Tesi Doctoral Barcelona, 29 de juliol de 2016 This thesis has received financial support from the Colombian government through the “Francisco José de Caldas” scholarship program of COLCIENCIAS and from the Corporación Universitaria Lasallista. DEDICATED TO A los que son la razón y la misión de esta tesis… LOS GATOS. A mis padres y hermanos. A Ismael. Vor mijn poffertje. ACKNOWLEDGMENTS Tal vez es la parte que se pensaría más fácil de escribir, pero sin duda se juntan muchos sentimientos al momento de mirar atrás y ver todo lo que has aprendido y todas las personas que han estado a tu lado dándote una palabra de aliento… y es ahí cuando se asoma la lágrima… Sin duda alguna, comienzo agradeciendo a los propietarios de todos los gatos incluidos en este estudio, sin ellos esto no habría sido posible. A continuación agradezco a mis directoras de tesis, la Dra. Rosa Novellas y la Dra. Yvonne Espada. Muchas gracias por creer en mí, por apoyarme y por tenerme tanta paciencia. He aprendido mucho de vosotras y por siempre les estaré muy agradecido. A mis patrocinadores en Colombia: Colciencias y La Corporación Universitaria Lasallista. Sin su apoyo económico, este sueño no se habría cumplido. Al servei de diagnòstic per l’imatge del Hospital Clínic Veterinari de la Universitat Autònoma de Barcelona. Judith Saura, Raúl Altuzarra, Carlo Anselmi, Eli Domínguez. Muchas gracias por vuestra amistad, compañerismo, enseñanzas, apoyo y confianza. Toda vuestra ayuda en gran parte han hecho posible esta tesis. También os agradezco el que me hayáis contagiado del mundo del diagnóstico por imagen que se ha convertido en mi sueño y mi pasión. Os quiero montones. To Maxim, your love and support, your patience helped me to keep this through and get the strength to finish it. Dank je wel schatje. A todo el personal del Hospital Clínic Veterinari de la Universitat Autònoma de Barcelona por el apoyo logístico, las palabras de ánimo, la ayuda en conseguir los pacientes y el cuidado ofrecido a los mismos durante su recuperación de la anestesia. Al servicio de anestesia del hospital, especialmente a Adrià Aguilar y Xavier Moll; siempre dispuestos para ayudarme de muy buena gana. Han sido muchas horas y muchos momentos de incertidumbre que hemos pasado juntos evaluando a todos los gatos, aprecio mucho todo lo que me apoyaron y aguantaron. A los servicios de bioquímica y hematología de la facultad de veterinaria por vuestra diligencia al procesar las muestras y en la lectura de las citologías. Montse, Toni y la Dra. Cuenca. A todos mis amigos en Colombia, Henry Daniel Espinosa, Juan Fernando Suárez, Héctor Buitrago, Luis Andrés Vergas, mis colegas veterinarios y mis compañeros de trabajo, por todo el apoyo y la compañía en la distancia. A mis amigos en España, Miquel Ciurana, Miquel Falla, Juan Luis Castillo, Robert Kempton, José Rodríguez, Ignasi Oliver, Fernando y Joan Franch vuestro apoyo y amistad es una de las mejores cosas que me ha pasado en mi estancia en Barcelona. Gracias por enseñarme vuestra cultura, por abrirme vuestros hogares y ayudarme a reconocer que en este mundo hay personas como vosotros que desinteresadamente se ayudan las unas a las otras. Os quiero montones. A Alejandro Durá, la amistad verdadera y el cariño sincero nacen de un corazón tan puro como el tuyo. Me has apoyado mucho más de lo que te puedas imaginar, siempre con tus palabras de ánimo, con tus consejos y tus soluciones a lo imprevisto. Estoy seguro que puedo seguir contando contigo para siempre. Te quiero un montón. Y por último, y no porque sea menos importante, sino por el contrario porque son mi vida entera, a mis padres y hermanos, a mi precioso sobrino Ismael. Esta tesis es por ustedes y el estar lejos durante tantos años ha sido un alto precio a pagar. Los amo demasiado y los extraño cada segundo que paso lejos de casa. Index ABBREVIATIONS .................................................................................................................... 19 1. INTRODUCTION ............................................................................................................. 23 2. LITERATURE REVIEW ..................................................................................................... 27 2.1. Anatomy of the lymphatic system in the domestic cat ......................................... 29 2.1.1. Lymph nodes (lymphonodi) ........................................................................... 29 2.1.2. Lymph centers (lymphocentrA) ...................................................................... 30 a. Head and neck lymph centers ........................................................................... 30 • Parotid lymph center (lymphocentrum pArotideum) .................................... 31 • Mandibular lymph center (lymphocentrum mAndibulare) ............................ 31 • Retropharyngeal lymph center (lymphocentrum retrophAryngeum) ............ 31 • Superficial cervical lymph center (lymphocentrum cervicAle superficiale) .... 32 • Deep cervical lymph center (lymphocentrum cervicAle profundum) ............. 32 b. Forelimb lymph center ...................................................................................... 33 • Axillary lymph center (lymphocentrum axillare) ........................................... 33 c. Thoracic lymph centers ..................................................................................... 34 • Dorsal thoracic lymph center (lymphocentrum thorAcicum dorsAle) ............ 34 • Ventral thoracic lymph center (lymphocentrum thorAcicum ventrAle) ......... 35 • Mediastinal lymph center (lymphocentrum mediastinAle) ........................... 36 • Bronchial lymph center (lymphocentrum bronchAle) .................................... 36 d. Abdominal and pelvic lymph centers ................................................................ 37 • Celiac lymph center (lymphocentrum celiacum) ........................................... 37 • Cranial mesenteric lymph center (lymphocentrum mesentericum crAniale) 38 • Caudal mesenteric lymph center (lymphocentrum mesentericum cAudAle) . 39 • Lumbar lymph center (lymphocentrum lumbAle) .......................................... 39 • Iliosacral lymph center (lymphocentrum iliosAcrAle) ..................................... 41 • Inguinofemoral lymph center (lymphocentrum inguinofemorAle) ................ 42 • Ischiatic lymph center (lymphcentrum ischiAdicum) ..................................... 43 e. Hindlimb lymph centers .................................................................................... 43 • Iliofemoral lymph center (lymphocentrum iliofemorAle) .............................. 44 • Popliteal lymph center (lymphocentrum popliteum) ..................................... 44 2.2. Ultrasonography of the lymphatic system ............................................................ 44 2.2.1. Physical principles ......................................................................................... 45 a. Propagation of sound ........................................................................................ 45 b. Frequency .......................................................................................................... 46 c. Wavelength ....................................................................................................... 46 d. Reflection .......................................................................................................... 46 e. Refraction .......................................................................................................... 46 f. Acoustic impedance .......................................................................................... 47 2.2.2. Modes of image display ................................................................................. 47 a. B-mode (Brightness mode, B-scan or gray scale) .............................................. 47 2.2.3. Instruments ................................................................................................... 48 2.2.4. Ultrasonography of the normal lymph nodes ............................................... 48 2.2.5. Ultrasonographic features of abnormal lymph nodes ................................... 50 2.3. Computed tomography of the lymphatic system .................................................. 51 2.3.1. CT principles .................................................................................................. 51 2.3.2. CT scans components .................................................................................... 52 a. Gantry ................................................................................................................ 52 b. X-ray tube .......................................................................................................... 52 c. Collimator .........................................................................................................
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